Artemisia annua (Sweet Annie), Other Artemisia Species, Artemisinin, Artemisinin Derivatives, and Malaria

This paper reviews the use of whole-plant Artemisia annua (sweet Annie) as it pertains to malaria including history, chemistry, clinical efficacy, pharmacokinetics, dosing, safety, and resistance. Artemisinin, the sesquiterpene lactone found in the plant, and various semi-synthetic variants of it used as critical drugs around the world for malaria are discussed in comparison to the whole plant. The multifaceted potential of A. annua against malaria including as a mosquito larvicide and to prevent transmission is discussed. The critical importance of combination therapy with this herb (be it with well-studied synthetic drugs or as-yet poorly studied natural products with activity against malaria, notably curcumin) is reviewed. The relevance of non-artemisinin chemicals in A. annua is highlighted. The pharmacokinetic and pharmacodynamic limitations of A. annua and artemisinins for prophylaxis against malaria are presented. Other Artemisia species besides A. annua, whether they contain artemisinin or not, are also touched upon in the context of malaria.